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CC: Left third digit numbness and wrist pain. HX: This 44 y/o LHM presented with a one month history of numbness and pain of the left middle finger and wrist. The numbness began in the left middle finger and gradually progressed over the course of a day to involve his wrist as well. Within a few days he developed pain in his wrist. He had been working as a cook and cut fish for prolonged periods of time. This activity exacerbated his symptoms. He denied any bowel/bladder difficulties, neck pain, or weakness. He had no history of neck injury. SHX/FHX: 1-2 ppd Cigarettes. Married. Off work for two weeks due to complaints. EXAM: Vital signs unremarkable. MS: A & O to person, place, time. Fluent speech without dysarthria. CN II-XII: Unremarkable,MOTOR: 5/5 throughout, including intrinsic muscles of hands. No atrophy or abnormal muscle tone. SENSORY: Decreased PP in third digit of left hand only (palmar and dorsal sides). STATION/GAIT/COORD: Unremarkable. REFLEXES: 1+ throughout, plantar responses were downgoing bilaterally. GEN EXAM: Unremarkable. Tinel's manuever elicited pain and numbness on the left. Phalens sign present on the left. CLINICAL IMPRESSION: Left Carpal Tunnel Syndrome,EMG/NCV: Unremarkable. MRI C-spine, 12/1/92: Congenitally small spinal canal is present. Superimposed on this is mild spondylosis and disc bulge at C6-7, C5-6, C4-5, and C3-4. There is moderate central spinal stenosis at C3-4. Intervertebral foramina at these levels appear widely patent. COURSE: The MRI findings did not correlate with the clinical findings and history. The patient was placed on Elavil and was subsequently lost to follow-up. |